BACKGROUND Endovascular mechanical thrombectomy (EMT) is the standard of care for acute ischemic stroke (AIS) caused by proximal large vessel occlusions. There is conflicting evidence on outcome of patients undergoing EMT under procedural sedation (PS) or general anesthesia (GA). In this retrospective study we analyze the effect of GA and PS on the functional outcome of patients undergoing EMT. METHODS Patients who have been admitted at our institute AIS and were treated with EMT under GA or PS between January 2015 and September 2018 were included in the study. Primary end point was the proportion of patients with good functional outcome as defined by a modified Rankin score (mRS) 0-2 at discharge. RESULTS A total of 155 patients were analyzed in this study including 45 (29.03 %) patients who received 97 GA, 110 (70.9 %) PS and 31 of these received Dexmedetomidine/Remifentanil. The median (IQR) 98 mRS at discharge was 4.0 (1.0-4.0) in the GA group Vs 3.00, (1.00-4.00) in the PS group. Among the secondary outcomes the lowest MAP recorded was significantly less in GA group (64.56 100 ± 18.70) compared to PS group (70.86 ± 16.30); p = 0.03. The PS group had a lower odd of mRS 3-5 (after adjustment), however, this finding was statistically not significant (OR 0.52 [0.07-3.5] 102 p = 0.5). CONCLUSIONS Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.

中文翻译：

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急性缺血性卒中和紧急机械血栓切除术：麻醉类型对早期结果的影响

背景血管内机械血栓切除术（EMT）是近端大血管闭塞引起的急性缺血性卒中（AIS）的标准治疗。在程序镇静 (PS) 或全身麻醉 (GA) 下接受 EMT 的患者的结果存在相互矛盾的证据。在这项回顾性研究中，我们分析了 GA 和 PS 对接受 EMT 患者功能结果的影响。方法 2015 年 1 月至 2018 年 9 月期间在我院 AIS 入院并在 GA 或 PS 下接受 EMT 治疗的患者纳入研究。主要终点是出院时改良 Rankin 评分 (mRS) 0-2 定义的良好功能结果的患者比例。结果 本研究共分析了 155 名患者，其中 45 名 (29.03 %) 患者接受了 97 次 GA，110 名 (70. 9 %) PS​​ 和其中 31 人接受了右美托咪定/瑞芬太尼。GA 组出院时的中位数 (IQR) 98 mRS 为 4.0 (1.0-4.0)，而 PS 组为 3.00 (1.00-4.00)。在次要结局中，与 PS 组（70.86 ± 16.30）相比，GA 组记录的最低 MAP（64.56 ± 18.70）显着降低；p = 0.03。PS 组的 mRS 3-5（调整后）的几率较低，但是，这一发现在统计学上不显着（OR 0.52 [0.07-3.5] 102 p = 0.5）。结论 我们的回顾性分析未发现 GA 与 PS 相比有任何影响，无论何时通过异丙酚靶控输注 (TCI) 或瑞芬太尼/右美托咪定 (REX) 对早期功能结果产生影响。在次要结局中，与 PS 组（70.86 ± 16.30）相比，GA 组记录的最低 MAP（64.56 ± 18.70）显着降低；p = 0.03。PS 组的 mRS 3-5（调整后）的几率较低，但是，这一发现在统计学上不显着（OR 0.52 [0.07-3.5] 102 p = 0.5）。结论 我们的回顾性分析未发现 GA 与 PS 相比有任何影响，无论何时通过异丙酚靶控输注 (TCI) 或瑞芬太尼/右美托咪定 (REX) 对早期功能结果产生影响。在次要结局中，与 PS 组（70.86 ± 16.30）相比，GA 组记录的最低 MAP（64.56 ± 18.70）显着降低；p = 0.03。PS 组的 mRS 3-5（调整后）的几率较低，但是，这一发现在统计学上不显着（OR 0.52 [0.07-3.5] 102 p = 0.5）。结论 我们的回顾性分析未发现 GA 与 PS 相比有任何影响，无论何时通过异丙酚靶控输注 (TCI) 或瑞芬太尼/右美托咪定 (REX) 对早期功能结果产生影响。